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all of Green Country Behavioral Health facilities. A copy of this may be found
in the Administrative Office of each GCBHS facility. If you have any questions
about this notice, please contact the Privacy Officer at 918-682-8407.


This notice describes our organization’s practices and that of:
· Any health care professional authorized to enter information into your
medical record.
· All departments and units of GCBHS.
· All employees, staff and other GCBHS personnel, including physicians,
psychologists, and therapists who are independent contractors of GCBHS.
· GCBHS, Inc. includes community mental health clinics and stabilization center
services. All these entities, sites, and locations shall follow the terms of this
notice and may share medical information with each other for treatment, payment
or health care operation purposes described in this notice.


We understand that medical information about you and
your health is personal and we are committed to protecting your medical
information. We create a record of the care and services you receive at GCBHS.
We need this record to provide you with quality care and to comply with certain
legal requirements. This notice applies to all of the records of your care
generated by GCBHS.

This notice will tell you
about the ways in which we may use and disclose medical information about you.
We also describe your rights and certain obligations we have regarding the use
and disclosure of medical information.

We are required by law to:
· make sure that medical information that identifies you is kept private;
· give you notice of our legal duties and privacy practices with respect to
medical information about you; and
· follow the terms of the notice that is currently in effect.

*Medical information
includes all protected health information: medical, mental health and substance


The following categories describe different ways that
we may use and disclose medical information without obtaining your
authorization in advance. For each category of uses or disclosures we will
explain what we mean and try to give an example. Not every use of disclosure in
a category will be listed. However, all of the ways we are permitted to use and
disclose information will fall within one of the categories.

Routine Uses

· For Treatment. We may
use medical information about you to provide you with medical treatment or
services. We may disclose medical information about you to doctors, nurses,
clinicians or other GCBHS personnel who are involved in taking care of you at
GCBHS. For example, a doctor prescribing medicine for you would need to know
other medications that you are taking and the reason for taking these medicines
to help prevent any medication interaction problems. Different areas of GCBHS
also may share medical information about you in order to coordinate the
different things you need, such as lab work, prescriptions and other testing.
This would also include the sharing of information among students of a
professional training program that GCBHS may sponsor. Information may also be
shared for purposes of treatment and follow-up with the Department of Mental
Health and Substance Abuse and their contractors if the client’s services are
being paid for by DMHSAS.

· For Payment. We may use
and disclose medical information about you so that the treatment and services
you receive at the GCBHS may be billed and payment may be collected from you,
an insurance company or a third party. We may disclose medical information to
your health plan, insurance company, HMO, or their utilization review
contractor to obtain prior approval or to determine whether your plan will
cover a particular treatment.

· For Healthcare
Operations. We may use and disclose medical information about you for
healthcare operations. These uses and disclosures are necessary to run GCBHS
and make sure that all of our clients receive quality care. For example, we may
use medical information to review our treatment and services and to evaluate
the performance of our staff in caring for you. We may also combine medical
information about many GCBHS clients to decide what additional services GCBHS
should offer, what services are not needed, and whether certain new treatments
are effective. We may also disclose information to doctors, nurses, clinicians
and other GCBHS personnel for review and learning purposes. We may also combine
the medical information we have with medical information from other healthcare
organizations to compare how we are doing and see whether we can make
improvements in the care and services we offer. We will remove information that
identifies you from this set of medical information so others may use it to
study health care and health care delivery without learning who the specific
patients are.

· Appointment Reminders.
We may use and disclose medical information to contact you as a reminder that
you have an appointment for services at GCBHS.

· Treatment Alternatives.
We may use and disclose medical information to tell you about or recommend
possible treatment options or alternatives that may be of interest to you.

· Health-Related Benefits
and Services. We may use and disclose medical information to tell you about
health-related benefits or services that may be of interest to you.

· As Required By Law. We
will disclose medical information about you when required to do so by federal,
state or local law such as those circumstances listed below under “Public
Health Risks”.

· To Avert a Serious
Threat to Health or Safety. We may use and disclose medical information about
you when necessary to prevent a serious threat to your health and safety or the
health and safety of the public or another person. Any disclosure, however, would
only be to someone able to help prevent the threat.

Special Situations

· Pharmaceutical Services.
We may release pertinent information about you to pharmacies for the purpose of
filling your GCBHS prescription.

· Workers’ Compensation.
We may release medical information about you to your employer or his/her
designee for workers’ compensation or similar programs. These programs provide
benefits for work-related injuries or illness.

· Public Health Risks. We
may disclose medical information about you for public health activities. These
activities generally include the following:
1. to prevent or control disease, injury or disability;
2. to report deaths;
3. to report child abuse or neglect;
4. to report reactions to medications or problems with products;
5. to notify people of recalls of products they may be using;
6. to notify a person who may have been exposed to a disease or may be at risk
for contracting or spreading a disease or condition;
7. to notify the appropriate government authority if we believe a patient has
been the victim of abuse or neglect.

· Health Oversight
Activities. We may disclose medical information to a health oversight agency
for activities authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure. These activities
are necessary for the government to monitor the health care system, government
programs, and compliance with civil rights laws.

· Accrediting
Organizations. We may disclose medical information to an organization that
GCBHS has contracted with for purposes of accreditation such as CARF, JCAHO,
the Department of Mental Health, and the Oklahoma Health Care Authority, etc. Lawsuits and Disputes. If you are involved in a lawsuit or a
dispute, we may disclose medical information about you in response to a court

· Law Enforcement. We may
release medical information if asked to do so by a law enforcement official:
1. In response to a court order, warrant, summons or similar process;
2. To identify or locate a suspect, fugitive, material witness, or missing
3. About the victim of a crime if, under certain limited circumstances, we are
unable to obtain the person’s agreement;
4. About a death we believe may be the result of criminal conduct;
5. About criminal conduct at the facility; and
6. In emergency circumstances to report a crime; the location of the crime or
victims; or the identity, description or location of the person who committed
the crime.

· Coroners, Medical
Examiners and Funeral Directors. We may release medical information to a
coroner or medical examiner. This may be necessary, for example, to identify a
deceased person or determine the cause of death. We may also release medical
information about patients of GCBHS to funeral directors as necessary to carry
out their duties.

· National Security and
Intelligence Activities. We may release medical information about you to
authorized federal officials for intelligence, counterintelligence and other
national security activities authorized by law.

· Protective Services for
the President and Others. We may disclose medical information about you to
authorized federal officials so they may provide protection to the President,
other authorized persons or foreign heads of state or conduct special

You have the following rights regarding medical information we maintain about

· Right to Inspect and
Copy. You have the right to request to inspect and copy medical information
that may be used to make decisions about your care. This request must be made
in writing to GCBHS. If you request a copy of the information, we may charge a
fee for the cost of copying, mailing or other supplies associated with your
request. The fee would be at the Oklahoma
statutory rate of .25 per copied page plus postage. If your request is denied
by the Clinical Director or Practitioner, you will receive a written
explanation for the denial.

· Right to Amend. If you
feel that medical information we have about you is incorrect or incomplete, you
may ask us to amend the information. You have the right to request an amendment
for as long as the information is kept by or for GCBHS.

To request an amendment,
your request must be made in writing and submitted to the Clinical Director for
GCBHS, 619 N. Main Street,
Muskogee, OK  74401. In addition, you must provide
a reason that supports your request.

We may deny your request
for an amendment if it is not in writing or does not include a reason to
support the request. In addition, we may deny your request if you ask us to
amend information that:
· was not created by us, unless the person or entity that created the
information is no longer available to make the amendment;
· is not part of the medical information kept by or for GCBHS;
· is not part of the information which you would be permitted to inspect and
copy; or
· is accurate and complete.

Right to
an Accounting of Disclosures. You have the right to request an “Accounting of
Disclosures.” This is a list of the disclosures we made of medical information
about you.

To request this list or
accounting of disclosures, you must submit your request in writing to GCBHS.
Your request must state a time period which may not be longer that six years
and may not include dates before April 14, 2003. The first list you request
within a 12 month period will be free. For additional lists, we may charge you
for the cost of providing the list. We will notify you of the cost involved and
you may choose to withdraw or modify your request at that time before any costs
are incurred.

· Right to Request
Restrictions. You have the right to request a restriction of limitation on the
medical information we use or disclose about you for treatment, payment or
health care operations. You also have the right to request a limit on the
medical information we disclose about you to someone who is involved in your
care or the payment for your care, like a family member or friend.

We are not required to
agree to your request. If we do agree, we will comply with your request unless
the information is needed to provide you emergency treatment.

To request restrictions,
you must make your request in writing to GCBHS. In your request, you must tell
us (1) what information you want to limit; (2) whether you want to limit our
use, disclosure or both; and (3) to whom you want the limits to apply, for
example, disclosures to your spouse.

· Right to Request
Confidential Communications. You have the right to request that we communicate
with you about medical matters in a certain way or at a certain location. For
example, you can ask that we only contact you at work or by mail.

To request confidential
communication, you must make your request in writing to GCBHS. We will not ask
you the reason for your request. We will accommodate all reasonable requests.
Your request must specify how or where you wish to be contacted.

· Right to a Paper Copy of
This Notice. You have the right to a paper copy of this notice. You may ask us
to give you a copy of this notice at any time. To obtain a paper copy of this
notice, please contact the Administrative office of any GCBHS facility.


We reserve the right to change this notice. We reserve the right to make the
revised or changed notice effective for medical information we already have
about you as well as any information we receive in the future. We will post a
copy of the current notice in the administrative office of each facility. The
notice will contain on the first page, in the top right-hand corner, the effective
date. In addition, each time you are admitted to the GCBHS for treatment or
health care services, we will offer you a copy of the current notice in effect.

If you believe your privacy rights have been violated, you may file a complaint
with GCBHS or with the Secretary of the Department of Health and Human
Services. To file a complaint with GCBHS, contact the Privacy Officer at
918-682-8407. All complaints must be submitted in writing. You will not be
penalized for filing a complaint.

Other uses and disclosures of medical information not covered by this notice or
the laws that apply to its use will be made only with your written permission.
If you provide us permission to use or disclose medical information about you,
you may revoke that permission, in writing, at any time. If you revoke your
permission, we will no longer use or disclose medical information about you for
the reasons covered by your written authorization. You understand that we are
unable to take back any disclosures we have already made with your permission,
and that we are required to retain our records of the care that we provide to


The confidentiality of
alcohol and drug abuse patient records maintained by GCBHS is protected by
Federal law and regulations. Generally, the program may not say to a person
outside the program that a patient attends the program, or disclose any
information identifying a patient as an alcohol or drug abuser UNLESS:
1. The patient consents in writing;
2. The disclosure is allowed by a court order; or
3. The disclosure is made to medical personnel in a medical emergency or to
personnel for research, audit, or program evaluation.

Violation of the Federal
law and regulations by a program is a crime. Suspected violations may be
reported to appropriate authorities in accordance with Federal regulations.

Federal law and
regulations do not protect any information about a crime committed by a patient
either at the program or against any person who works for the program or about
any threat to commit such a crime.

Federal laws and
regulations do not protect any information about suspected child abuse or
neglect from being reported under State law to appropriate State or local

(See 42 U.S.C. 290dd-3 and
42 U.S.C. 290ee-3 for Federal laws and 42 CFR part 2 for Federal regulations.)

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